Impact of Trauma System Structure on Injury Outcomes

A Systematic Review and Meta-Analysis

Lynne Moore, Howard Champion, Pier Alexandre Tardif, Brice Lionel Kuimi, Gerard O’Reilly, Ari Leppaniemi, Peter Cameron, Cameron S. Palmer, Fikri M. Abu-Zidan, Belinda Gabbe, Christine Gaarder, Natalie Yanchar, Henry Thomas Stelfox, Raul Coimbra, John Kortbeek, Vanessa K. Noonan, Amy Gunning, Malcolm Gordon, Monty Khajanchi, Teegwendé V. Porgo & 3 others Alexis F. Turgeon, Luke Leenen, On behalf of the International Injury Care Improvement Initiative

Research output: Contribution to journalReview ArticleResearchpeer-review

11 Citations (Scopus)

Abstract

Background: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. Results: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. Conclusions: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.

Original languageEnglish
Pages (from-to)1327-1339
Number of pages13
JournalWorld Journal of Surgery
Volume42
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Cite this

Moore, L., Champion, H., Tardif, P. A., Kuimi, B. L., O’Reilly, G., Leppaniemi, A., ... On behalf of the International Injury Care Improvement Initiative (2018). Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis. World Journal of Surgery, 42(5), 1327-1339. https://doi.org/10.1007/s00268-017-4292-0
Moore, Lynne ; Champion, Howard ; Tardif, Pier Alexandre ; Kuimi, Brice Lionel ; O’Reilly, Gerard ; Leppaniemi, Ari ; Cameron, Peter ; Palmer, Cameron S. ; Abu-Zidan, Fikri M. ; Gabbe, Belinda ; Gaarder, Christine ; Yanchar, Natalie ; Stelfox, Henry Thomas ; Coimbra, Raul ; Kortbeek, John ; Noonan, Vanessa K. ; Gunning, Amy ; Gordon, Malcolm ; Khajanchi, Monty ; Porgo, Teegwendé V. ; Turgeon, Alexis F. ; Leenen, Luke ; On behalf of the International Injury Care Improvement Initiative. / Impact of Trauma System Structure on Injury Outcomes : A Systematic Review and Meta-Analysis. In: World Journal of Surgery. 2018 ; Vol. 42, No. 5. pp. 1327-1339.
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title = "Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis",
abstract = "Background: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. Results: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. Conclusions: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.",
author = "Lynne Moore and Howard Champion and Tardif, {Pier Alexandre} and Kuimi, {Brice Lionel} and Gerard O’Reilly and Ari Leppaniemi and Peter Cameron and Palmer, {Cameron S.} and Abu-Zidan, {Fikri M.} and Belinda Gabbe and Christine Gaarder and Natalie Yanchar and Stelfox, {Henry Thomas} and Raul Coimbra and John Kortbeek and Noonan, {Vanessa K.} and Amy Gunning and Malcolm Gordon and Monty Khajanchi and Porgo, {Teegwend{\'e} V.} and Turgeon, {Alexis F.} and Luke Leenen and {On behalf of the International Injury Care Improvement Initiative}",
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Moore, L, Champion, H, Tardif, PA, Kuimi, BL, O’Reilly, G, Leppaniemi, A, Cameron, P, Palmer, CS, Abu-Zidan, FM, Gabbe, B, Gaarder, C, Yanchar, N, Stelfox, HT, Coimbra, R, Kortbeek, J, Noonan, VK, Gunning, A, Gordon, M, Khajanchi, M, Porgo, TV, Turgeon, AF, Leenen, L & On behalf of the International Injury Care Improvement Initiative 2018, 'Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis', World Journal of Surgery, vol. 42, no. 5, pp. 1327-1339. https://doi.org/10.1007/s00268-017-4292-0

Impact of Trauma System Structure on Injury Outcomes : A Systematic Review and Meta-Analysis. / Moore, Lynne; Champion, Howard; Tardif, Pier Alexandre; Kuimi, Brice Lionel; O’Reilly, Gerard; Leppaniemi, Ari; Cameron, Peter; Palmer, Cameron S.; Abu-Zidan, Fikri M.; Gabbe, Belinda; Gaarder, Christine; Yanchar, Natalie; Stelfox, Henry Thomas; Coimbra, Raul; Kortbeek, John; Noonan, Vanessa K.; Gunning, Amy; Gordon, Malcolm; Khajanchi, Monty; Porgo, Teegwendé V.; Turgeon, Alexis F.; Leenen, Luke; On behalf of the International Injury Care Improvement Initiative.

In: World Journal of Surgery, Vol. 42, No. 5, 01.05.2018, p. 1327-1339.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Impact of Trauma System Structure on Injury Outcomes

T2 - A Systematic Review and Meta-Analysis

AU - Moore, Lynne

AU - Champion, Howard

AU - Tardif, Pier Alexandre

AU - Kuimi, Brice Lionel

AU - O’Reilly, Gerard

AU - Leppaniemi, Ari

AU - Cameron, Peter

AU - Palmer, Cameron S.

AU - Abu-Zidan, Fikri M.

AU - Gabbe, Belinda

AU - Gaarder, Christine

AU - Yanchar, Natalie

AU - Stelfox, Henry Thomas

AU - Coimbra, Raul

AU - Kortbeek, John

AU - Noonan, Vanessa K.

AU - Gunning, Amy

AU - Gordon, Malcolm

AU - Khajanchi, Monty

AU - Porgo, Teegwendé V.

AU - Turgeon, Alexis F.

AU - Leenen, Luke

AU - On behalf of the International Injury Care Improvement Initiative

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. Results: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. Conclusions: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.

AB - Background: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. Results: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. Conclusions: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.

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U2 - 10.1007/s00268-017-4292-0

DO - 10.1007/s00268-017-4292-0

M3 - Review Article

VL - 42

SP - 1327

EP - 1339

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 5

ER -